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2.
  • Barber, R. M., et al. (author)
  • Healthcare access and quality index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015 : A novel analysis from the global burden of disease study 2015
  • 2017
  • In: The Lancet. - : Lancet Publishing Group. - 0140-6736 .- 1474-547X. ; 390:10091, s. 231-266
  • Journal article (peer-reviewed)abstract
    • Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright © The Author(s). Published by Elsevier Ltd.
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3.
  • Barber, R. M., et al. (author)
  • Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015
  • 2017
  • In: Lancet. - : Elsevier BV. - 0140-6736. ; 390:10091, s. 231-266
  • Journal article (peer-reviewed)abstract
    • Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r= 0.88), an index of 11 universal health coverage interventions (r= 0.83), and human resources for health per 1000 (r= 0.77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28.6 to 94.6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40.7 (95% uncertainty interval, 39.0-42.8) in 1990 to 53.7 (52.2-55.4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21.2 in 1990 to 20.1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73.8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-systemcharacteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright (C) The Author(s). Published by Elsevier Ltd.
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4.
  • Crump, Casey, et al. (author)
  • Adult outcomes of preterm birth
  • 2016
  • In: Preventive Medicine. - : Elsevier BV. - 0091-7435. ; 91, s. 400-401
  • Journal article (peer-reviewed)abstract
    • Because of remarkable advances in the treatment of preterm birth, physicians increasingly encounter adult patients who were born preterm. However, research now shows that improved early survival may come at the expense of future health risks, including increased respiratory, cardiovascular, and kidney disease, diabetes and metabolic syndrome, and neuropsychiatric disorders. Unfortunately, this knowledge is not yet reflected in patient care. The NIH recently convened a conference of multidisciplinary international experts who called for better awareness among physicians regarding adult outcomes of preterm birth, which is critically needed for enabling them to identify and provide better care for these patients across the life course. This Letter aims to promote awareness of this issue among physicians in order to inform long-term patient care and policy. The continued high (~ 10%) prevalence of preterm birth and unprecedented numbers who are surviving into adulthood mean that the long-term health effects will have a growing clinical and public health impact in the future.
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5.
  • Crump, Casey, et al. (author)
  • Adverse Pregnancy Outcomes and Long-Term Mortality in Women
  • In: JAMA Internal Medicine. - 2168-6114.
  • Journal article (peer-reviewed)abstract
    • Importance: Women with adverse pregnancy outcomes, such as preterm delivery or preeclampsia, have higher future risks of cardiometabolic disorders; however, little is known about their long-term mortality risks. A better understanding of such risks is needed to facilitate early identification of high-risk women and preventive actions. Objective: To determine long-term mortality risks associated with 5 major adverse pregnancy outcomes in a large population-based cohort of women. Design, Setting, and Participants: This national cohort study in Sweden used the Swedish Medical Birth Register, containing prenatal and birth information for nearly all deliveries in Sweden since 1973, to identify women who had a singleton delivery during 1973 to 2015. All 2195667 such women with information for pregnancy duration and infant birth weight were included in the study. Data were analyzed from March to September 2023. Exposure: Adverse pregnancy outcomes (preterm delivery, small for gestational age, preeclampsia, other hypertensive disorders, and gestational diabetes), identified from nationwide birth records. Main Outcome and Measures: All-cause and cause-specific mortality through December 31, 2018. Cox regression was used to compute hazard ratios (HRs) for mortality associated with specific adverse pregnancy outcomes, adjusted for other maternal factors. Cosibling analyses assessed for confounding by shared familial (genetic or environmental) factors. Results: In 56 million person-years of follow-up to a median (IQR) age of 52 (42-61) years, 88055 women (4%) died (median [IQR] age at death, 59 [50-67] years). All 5 adverse pregnancy outcomes were independently associated with increased mortality. Across the entire follow-up (≤46 years after delivery), adjusted HRs for all-cause mortality associated with specific adverse pregnancy outcomes were as follows: gestational diabetes, 1.52 (95% CI, 1.46-1.58); preterm delivery, 1.41 (95% CI, 1.37-1.44); small for gestational age, 1.30 (95% CI, 1.28-1.32); other hypertensive disorders, 1.27 (95% CI, 1.19-1.37); and preeclampsia, 1.13 (95% CI, 1.10-1.16). All HRs remained significantly elevated even 30 to 46 years after delivery. These effect sizes were only partially (0%-45%) reduced after controlling for shared familial factors in cosibling analyses. Women who experienced multiple adverse pregnancy outcomes had further increases in risk. Several major causes of death were identified, including cardiovascular and respiratory disorders and diabetes. Conclusions and Relevance: In this large national cohort study, women who experienced any of 5 major adverse pregnancy outcomes had increased mortality risks that remained elevated more than 40 years later. Women with adverse pregnancy outcomes need early preventive evaluation and long-term follow-up for detection and treatment of chronic disorders associated with premature mortality.
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6.
  • Crump, Casey, et al. (author)
  • Adverse pregnancy outcomes and long-term risk of chronic kidney disease in women : national cohort and co-sibling study
  • In: American Journal of Obstetrics and Gynecology. - 0002-9378.
  • Journal article (peer-reviewed)abstract
    • Background: Women with adverse pregnancy outcomes may have higher subsequent risk of chronic kidney disease, but the long-term independent risks and potential causality are unclear. Objective: This study aimed to determine long-term risks of chronic kidney disease associated with 5 major adverse pregnancy outcomes in a large population-based cohort, and to assess for familial confounding using co-sibling analyses. Study Design: A national cohort study was conducted of all 2,201,279 women with a singleton delivery in Sweden from 1973 to 2015, followed up for chronic kidney disease identified from nationwide diagnoses through 2018. Cox regression was used to compute hazard ratios for chronic kidney disease associated with preterm delivery, small for gestational age, preeclampsia, other hypertensive disorders, and gestational diabetes, adjusting for other adverse pregnancy outcomes and maternal factors. Co-sibling analyses assessed for potential confounding by shared familial (genetic or environmental) factors. Results: In 56 million person-years of follow-up, 11,572 (0.5%) women were diagnosed with chronic kidney disease (median age, 61 years). All 5 adverse pregnancy outcomes were independently associated with increased chronic kidney disease risk. Within 10 years following delivery, adjusted hazard ratios associated with specific adverse pregnancy outcomes were: 7.12 for other hypertensive disorders (95% confidence interval, 5.88–8.62), 4.38 for preeclampsia (3.72–5.16), 3.50 for preterm delivery (2.95–4.15), 3.15 for gestational diabetes (2.53–3.92), and 1.22 for small for gestational age (1.02–1.44). All hazard ratios remained significantly elevated even 30 to 46 years after delivery (gestational diabetes, 3.32 [95% confidence interval, 2.96–3.72]; other hypertensive disorders, 2.44 [1.91–3.11]; preeclampsia, 2.03 [1.90–2.16]; preterm delivery, 1.56 [1.44–1.68]; and small for gestational age, 1.24 [1.16–1.31]). These findings were only partially (0%–45%) explained by shared familial factors. Women with multiple adverse pregnancy outcomes had further increases in risk. Conclusion: In this large national cohort, women who experienced any of 5 major adverse pregnancy outcomes had increased risk for chronic kidney disease up to 46 years later. Women with adverse pregnancy outcomes need early preventive actions and long-term monitoring to reduce risk of chronic kidney disease.
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7.
  • Crump, Casey, et al. (author)
  • Adverse pregnancy outcomes and long term risk of ischemic heart disease in mothers : national cohort and co-sibling study
  • 2023
  • In: BMJ. - : BMJ. - 0959-8146 .- 1756-1833. ; 380
  • Journal article (peer-reviewed)abstract
    • Objective: To examine the associations between five major adverse pregnancy outcomes and long term risks of ischemic heart disease in mothers. Design: National cohort study. Setting: Sweden. Participants: All 2 195 266 women with a first singleton delivery in Sweden during 1973-2015. Main outcome measures: The main outcome measure was incidence of ischemic heart disease from delivery to 2018, identified from nationwide inpatient and outpatient diagnoses. Cox regression was used to calculate hazard ratios for ischemic heart disease associated with preterm delivery, small for gestational age, pre-eclampsia, other hypertensive disorders of pregnancy, and gestational diabetes, adjusting for other adverse pregnancy outcomes and maternal factors. Co-sibling analyses assessed for confounding by shared familial (genetic and environmental) factors. Results: During 53.6 million person years of follow-up, ischemic heart disease was diagnosed in 83 881 (3.8%) women. All five adverse pregnancy outcomes were independently associated with increased risk of ischemic heart disease. In the 10 years after delivery, adjusted hazard ratios for ischemic heart disease associated with specific adverse pregnancy outcomes were 2.09 (95% confidence interval 1.77 to 2.46) for other hypertensive disorders of pregnancy, 1.72 (1.55 to 1.90) for preterm delivery, 1.54 (1.37 to 1.72) for pre-eclampsia, 1.30 (1.09 to 1.56) for gestational diabetes, and 1.10 (1.00 to 1.21) for small for gestational age. The hazard ratios remained significantly increased even 30-46 years after delivery: 1.47 (1.30 to 1.66) for other hypertensive disorders of pregnancy, 1.40 (1.29 to 1.51) for gestational diabetes, 1.32 (1.28 to 1.36) for pre-eclampsia, 1.23 (1.19 to 1.27) for preterm delivery, and 1.16 (1.13 to 1.19) for small for gestational age. These findings were only partially (<45%) explained by shared familial (genetic or environmental) factors. Women who experienced multiple adverse pregnancy outcomes showed further increases in risk (eg, <10 years after delivery, adjusted hazard ratios associated with 1, 2, or ≥3 adverse pregnancy outcomes were 1.29 (1.19 to 1.39), 1.80 (1.59 to 2.03), and 2.26 (1.89 to 2.70), respectively)). Conclusions: In this large national cohort, women who experienced any of five major adverse pregnancy outcomes showed an increased risk for ischemic heart disease up to 46 years after delivery. Women with adverse pregnancy outcomes should be considered for early preventive evaluation and long term risk reduction to help prevent the development of ischemic heart disease.
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8.
  • Crump, Casey, et al. (author)
  • Aerobic fitness, muscular strength and obesity in relation to risk of heart failure
  • 2017
  • In: Heart. - : BMJ. - 1355-6037 .- 1468-201X. ; 103:22, s. 1780-1787
  • Journal article (peer-reviewed)abstract
    • Objective Low physical fitness and obesity have been associated with higher risk of developing heart failure (HF), but their interactive effects are unknown. Elucidation of interactions among these common modifiable factors may help facilitate more effective primary prevention. Methods We conducted a national cohort study to examine the interactive effects of aerobic fitness, muscular strength and body mass index (BMI) among 1 330 610 military conscripts in Sweden during 1969-1997 (97%-98% of all 18-year-old men) on risk of HF identified from inpatient and outpatient diagnoses through 2012 (maximum age 62 years). Results There were 11 711 men diagnosed with HF in 37.8 million person-years of follow-up. Low aerobic fitness, low muscular strength and obesity were independently associated with higher risk of HF, after adjusting for each other, socioeconomic factors, other chronic diseases and family history of HF. The combination of low aerobic fitness and low muscular strength (lowest vs highest tertiles) was associated with a 1.7-fold risk of HF (95% CI 1.6 to 1.9; p<0.001; incidence rates per 100 000 person-years, 43.2 vs 10.8). These factors had positive additive and multiplicative interactions (p<0.001) and were associated with increased risk of HF even among men with normal BMI. Conclusions Low aerobic fitness, low muscular strength and obesity at the age of 18 years were independently associated with higher risk of HF in adulthood, with interactive effects between aerobic fitness and muscular strength. These findings suggest that early-life interventions may help reduce the long-term risk of HF and should include both aerobic fitness and muscular strength, even among persons with normal BMI.
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9.
  • Crump, Casey, et al. (author)
  • Association of Preterm Birth with Long-term Risk of Heart Failure into Adulthood
  • 2021
  • In: JAMA Pediatrics. - : American Medical Association (AMA). - 2168-6203. ; 175:7, s. 689-697
  • Journal article (peer-reviewed)abstract
    • Importance: Preterm birth has been associated with increased risk of heart failure (HF) early in life, but its association with new-onset HF in adulthood appears to be unknown. Objective: To determine whether preterm birth is associated with increased risk of HF from childhood into mid-adulthood in a large population-based cohort. Design, Setting, and Participants: This national cohort study was conducted in Sweden with data from 1973 through 2015. All singleton live births in Sweden during 1973 through 2014 were included. Exposures: Gestational age at birth, identified from nationwide birth records. Main Outcomes and Measures: Heart failure, as identified from inpatient and outpatient diagnoses through 2015. Cox regression was used to determine hazard ratios (HRs) for HF associated with gestational age at birth while adjusting for other perinatal and maternal factors. Cosibling analyses assessed for potential confounding by unmeasured shared familial (genetic and/or environmental) factors. Results: A total of 4193069 individuals were included (maximum age, 43 years; median age, 22.5 years). In 85.0 million person-years of follow-up, 4158 persons (0.1%) were identified as having HF (median [interquartile range] age, 15.4 [28.0] years at diagnosis). Preterm birth (gestational age <37 weeks) was associated with increased risk of HF at ages younger than 1 year (adjusted HR [aHR], 4.49 [95% CI, 3.86-5.22]), 1 to 17 years (aHR, 3.42 [95% CI, 2.75-4.27]), and 18 to 43 years (aHR, 1.42 [95% CI, 1.19-1.71]) compared with full-term birth (gestational age, 39-41 weeks). At ages 18 through 43 years, the HRs further stratified by gestational age were 4.72 (95% CI, 2.11-10.52) for extremely preterm births (22-27 weeks), 1.93 (95% CI, 1.37-2.71) for moderately preterm births (28-33 weeks), 1.24 (95% CI, 1.00-1.54) for late preterm births (34-36 weeks), and 1.09 (95% CI, 0.97-1.24) for early term births (37-38 weeks). The corresponding HF incidence rates (per 100000 person-years) at ages 18 through 43 years were 31.7, 13.8, 8.7, and 7.3, respectively, compared with 6.6 for full-term births. These associations persisted when excluding persons with structural congenital cardiac anomalies. The associations at ages 18 through 43 years (but not <18 years) appeared to be largely explained by shared determinants of preterm birth and HF within families. Preterm birth accounted for a similar number of HF cases among male and female individuals. Conclusions and Relevance: In this large national cohort, preterm birth was associated with increased risk of new-onset HF into adulthood. Survivors of preterm birth may need long-term clinical follow-up into adulthood for risk reduction and monitoring for HF.
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10.
  • Crump, Casey, et al. (author)
  • Association of Preterm Birth with Risk of Ischemic Heart Disease in Adulthood
  • 2019
  • In: JAMA Pediatrics. - : American Medical Association (AMA). - 2168-6203. ; 173:8, s. 736-736
  • Journal article (peer-reviewed)abstract
    • Importance: Preterm birth has previously been associated with increased risks of hypertension and diabetes, but not ischemic heart disease (IHD), in adulthood. The reasons for this lack of association with IHD despite associations with its risk factors have been elusive, but may be associated with methodologic issues, such as survivor bias, in prior studies. Objective: To determine whether preterm birth is associated with an increased risk of IHD in adulthood in a large population-based cohort. Design, Setting, and Participants: This national, population-based cohort study included all 2141709 persons who were born as singleton live births in Sweden during 1973 to 1994. The data were analyzed in September 2018. Exposures: Gestational age at birth, identified from nationwide birth records in the Swedish Birth Registry. Main Outcomes and Measures: Ischemic heart disease that was identified from nationwide inpatient and outpatient diagnoses through 2015 (maximum age, 43 years). A Cox regression was used to examine gestational age at birth in association with IHD in adulthood while adjusting for other perinatal and maternal factors. Cosibling analyses assessed for potential confounding by unmeasured shared familial factors. Results: Of 2141709 participants, 1041906 (48.6%) were female and there were 1921 persons (0.09%) who received a diagnosis of IHD in 30.9 million person-years of follow-up. Gestational age at birth was inversely associated with IHD risk in adulthood. At ages 30 to 43 years, adjusted hazard ratios for IHD associated with preterm (gestational age <37 weeks) and early-term birth (37-38 weeks) were 1.53 (95% CI, 1.20-1.94) and 1.19 (1.01-1.40), respectively, compared with full-term birth (39-41 weeks). Preterm-born women had lower IHD incidence than preterm-born men (15.16 vs 22.00 per 100000 person-years) but had a higher adjusted hazard ratio (1.93; 95% CI, 1.28-2.90 vs 1.37; 95% CI, 1.01-1.84). These associations did not appear to be explained by shared genetic or environmental factors in families. Conclusions and Relevance: In this large national cohort, preterm and early-term birth were associated with an increased IHD risk in adulthood. Persons born prematurely need early evaluation and preventive actions to reduce the risk of IHD.
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11.
  • Crump, Casey, et al. (author)
  • Cardiorespiratory fitness and long-term risk of sleep apnea : A national cohort study
  • 2019
  • In: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 28:6
  • Journal article (peer-reviewed)abstract
    • Sleep apnea is increasing in prevalence, and is an important cause of cardiometabolic diseases and mortality worldwide. Its only established modifiable risk factor is obesity; however, up to half of all sleep apnea cases may occur in non-obese persons, and hence there is a pressing need to identify other modifiable risk factors to facilitate more effective prevention. We sought to examine, for the first time, cardiorespiratory fitness in relation to the risk of sleep apnea, independent of obesity. A national cohort study was conducted to examine cardiorespiratory fitness in all 1,547,478 Swedish military conscripts during 1969–1997 (97%–98% of all 18-year-old men) in relation to risk of sleep apnea through 2012 (maximum age 62 years). Cardiorespiratory fitness was measured as maximal aerobic workload in Watts, and sleep apnea was identified from nationwide outpatient and inpatient diagnoses. A total of 44,612 (2.9%) men were diagnosed with sleep apnea in 43.7 million person-years of follow-up. Adjusting for age, height, weight, socioeconomic factors and family history of sleep apnea, low cardiorespiratory fitness at age 18 years was associated with a significantly increased risk of sleep apnea in adulthood (lowest versus highest cardiorespiratory fitness tertile: incidence rate ratio, 1.44; 95% confidence interval, 1.40–1.49; p < 0.001; continuous cardiorespiratory fitness per 100 Watts: incidence rate ratio, 0.71; 95% confidence interval, 0.70–0.73; p < 0.001). An increased risk was observed even among men with normal body mass index (lowest versus highest cardiorespiratory fitness tertile: incidence rate ratio, 1.30; 95% confidence interval, 1.26–1.35; p < 0.001). These findings identify low cardiorespiratory fitness early in life as a new modifiable risk factor for development of sleep apnea in adulthood.
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12.
  • Crump, Casey, et al. (author)
  • Comorbidities and Mortality in Bipolar Disorder A Swedish National Cohort Study
  • 2013
  • In: JAMA Psychiatry. - : American Medical Association (AMA). - 2168-6238 .- 2168-622X. ; 70:9, s. 931-939
  • Journal article (peer-reviewed)abstract
    • IMPORTANCE Bipolar disorder is associated with premature mortality, but the specific causes and underlying pathways are unclear. OBJECTIVE To examine the physical health effects of bipolar disorder using outpatient and inpatient data for a national population. DESIGN, SETTING, AND PARTICIPANTS National cohort study of 6 587 036 Swedish adults, including 6618 with bipolar disorder. MAIN OUTCOMES AND MEASURES Physical comorbidities diagnosed in any outpatient or inpatient setting nationwide and mortality (January 1, 2003, through December 31, 2009). RESULTS Women and men with bipolar disorder died 9.0 and 8.5 years earlier on average than the rest of the population, respectively. All-cause mortality was increased 2-fold among women (adjusted hazard ratio [aHR], 2.34; 95% CI, 2.16-2.53) and men (aHR, 2.03; 95% CI, 1.85-2.23) with bipolar disorder, compared with the rest of the population. Patients with bipolar disorder had increased mortality from cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), influenza or pneumonia, unintentional injuries, and suicide for both women and men and cancer for women only. Suicide risk was 10-fold among women (aHR, 10.37; 95% CI, 7.36-14.60) and 8-fold among men (aHR, 8.09; 95% CI, 5.98-10.95) with bipolar disorder, compared with the rest of the population. Substance use disorders contributed only modestly to these findings. The association between bipolar disorder and mortality from chronic diseases (ischemic heart disease, diabetes, COPD, or cancer) was weaker among persons with a prior diagnosis of these conditions (aHR, 1.40; 95% CI, 1.26-1.56) than among those without a prior diagnosis (aHR, 2.38; 95% CI, 1.95-2.90; P-interaction = .01). CONCLUSIONS AND RELEVANCE In this large national cohort study, patients with bipolar disorder died prematurely from multiple causes, including cardiovascular disease, diabetes, COPD, influenza or pneumonia, unintentional injuries, and suicide. However, chronic disease mortality among those with more timely medical diagnosis approached that of the general population, suggesting that better provision of primary medical care may effectively reduce premature mortality among persons with bipolar disorder.
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13.
  • Crump, Casey, et al. (author)
  • Comorbidities and Mortality in Persons With Schizophrenia: A Swedish National Cohort Study
  • 2013
  • In: American Journal of Psychiatry. - : American Psychiatric Association Publishing. - 1535-7228 .- 0002-953X. ; 170:3, s. 324-333
  • Journal article (peer-reviewed)abstract
    • Objective: Schizophrenia is associated with premature mortality, but the specific causes and pathways are unclear. The authors used outpatient and inpatient data for a national population to examine the association between schizophrenia and mortality and comorbidities. Method: This was a national cohort study of 6,097,834 Swedish adults, including 8,277 with schizophrenia, followed for 7 years (2003-2009) for mortality and comorbidities diagnosed in any outpatient or inpatient setting nationwide. Results: On average, men with schizophrenia died 15 years earlier, and women 12 years earlier, than the rest of the population, and this was not accounted for by unnatural deaths. The leading causes were ischemic heart disease and cancer. Despite having twice as many health care system contacts, schizophrenia patients had no increased risk of nonfatal ischemic heart disease or cancer diagnoses, but they had an elevated mortality from ischemic heart disease (adjusted hazard ratio for women, 3.33 [95% CI=2.73-4.05]; for men, 2.20 [95%, CI=1.83-2.65]) and cancer (adjusted hazard ratio for women, 1.71 [95% CI=1.38-2.10; for men, 1.44 [95% CI=1.15-1.80]). Among all people who died from ischemic heart disease or cancer, schizophrenia patients Were less likely than others to have been diagnosed previously with these conditions (for ischemic heart disease, 26.3% compared with 43.7%; for cancer, 73.9% compared with 82.3%). The association between schizophrenia and mortality was stronger among women and the employed. Lack of antipsychotic treatment was also associated with elevated mortality.. Conclusions: Schizophrenia patients had markedly premature mortality, and the leading causes were ischemic heart disease and cancer, which appeared to be under-diagnosed. Preventive interventions should prioritize primary health care tailored to this population, including more effective risk modification and screening for cardiovascular disease and cancer. (Am J Psychiatty 2013; 170:324-333)
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14.
  • Crump, Casey, et al. (author)
  • Comparative risk of suicide by specific substance use disorders : A national cohort study
  • 2021
  • In: Journal of Psychiatric Research. - : Elsevier BV. - 0022-3956. ; 144, s. 247-254
  • Journal article (peer-reviewed)abstract
    • Substance use disorders (SUDs) are important risk factors for suicide, yet little is known about how suicide risks vary by specific SUDs. We examined these risks for the first time in a large general population to facilitate comparisons across SUDs. A national cohort study was conducted of all 6,947,191 adults in Sweden. SUDs (opioid, sedative/hypnotic, hallucinogen, cannabis, amphetamine, cocaine, and alcohol use disorders) were identified using inpatient, outpatient, and crime data, and suicide deaths using nationwide death data with follow-up during 2003–2016. Cox regression was used to compute hazard ratios (HRs) for suicide death while adjusting for sociodemographic factors and psychiatric, SUD, and somatic comorbidities. Co-sibling analyses assessed for confounding by unmeasured shared familial (genetic and/or environmental) factors. In 79.8 million person-years of follow-up, 15,616 (0.2%) suicide deaths were identified. All SUDs were associated with significantly increased risks, with HRs ranging from 12- to 26-fold and 2.5- to 6.4-fold before and after adjusting for covariates, respectively. After adjusting for all covariates, opioid use disorder was the strongest risk factor (HR, 6.39; 95% CI, 5.53–7.38) (P ≤ 0.002 compared with any other SUD), followed by sedative/hypnotic use disorder (4.62; 4.06–5.27) (P ≤ 0.009 compared with any other SUD except opioid or hallucinogen). Most associations persisted after controlling for shared familial factors, consistent with causal effects. In this large national cohort, all SUDs were associated with significantly increased risks of suicide death, especially opioid and sedative/hypnotic use disorders. These findings may improve risk stratification and inform interventions to prevent suicide in the highest-risk subgroups with SUDs.
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15.
  • Crump, Casey, et al. (author)
  • Early-Life Cardiorespiratory Fitness and Long-term Risk of Prostate Cancer
  • 2020
  • In: Cancer Epidemiology, Biomarkers and Prevention. - 1055-9965 .- 1538-7755. ; 29:11, s. 2187-2194
  • Journal article (peer-reviewed)abstract
    • Background: Adolescence is a period of rapid prostatic growth, yet is understudied for susceptibility for future risk of prostate cancer. We examined cardiorespiratory fitness (CRF) in late adolescence in relation to long-term prostate cancer risk.Methods: A population-based cohort study was conducted of all 699,125 Swedish military conscripts during 1972–1985 (97%–98% of 18-year-old men) in relation to risk of prostate cancer overall, aggressive prostate cancer, and prostate cancer mortality during 1998–2017 (ages 50–65 years). CRF was measured by maximal aerobic workload, and prostate cancer was ascertained using the National Prostate Cancer Register. Muscle strength was examined as a secondary predictor.Results: In 38.8 million person-years of follow-up, 10,782 (1.5%) men were diagnosed with prostate cancer. Adjusting for sociodemographic factors, height, weight, and family history of prostate cancer, high CRF was associated with a slightly increased risk of any prostate cancer [highest vs. lowest quintile: incidence rate ratio (IRR), 1.10; 95% CI, 1.03–1.19; P = 0.008], but was neither significantly associated with aggressive prostate cancer (1.01; 0.85–1.21; P = 0.90) nor prostate cancer mortality (1.24; 0.73–2.13; P = 0.42). High muscle strength also was associated with a modestly increased risk of any prostate cancer (highest vs. lowest quintile: IRR, 1.14; 95% CI, 1.07–1.23; P < 0.001), but neither with aggressive prostate cancer (0.88; 0.74–1.04; P = 0.14) nor prostate cancer mortality (0.81; 0.48–1.37; P = 0.43).Conclusions: High CRF or muscle strength in late adolescence was associated with slightly increased future risk of prostate cancer, possibly related to increased screening, but neither with risk of aggressive prostate cancer nor prostate cancer mortality.Impact: These findings illustrate the importance of distinguishing aggressive from indolent prostate cancer and assessing for potential detection bias.
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16.
  • Crump, Casey, et al. (author)
  • Early-term Birth (37-38 Weeks) and Mortality in Young Adulthood.
  • 2013
  • In: Epidemiology. - 1531-5487.
  • Journal article (peer-reviewed)abstract
    • BACKGROUND:: Early-term birth (gestational age, 37-38 weeks) has been associated with increased infant mortality relative to later-term birth, but mortality beyond infancy has not been studied. We examined the association between early-term birth and mortality through young adulthood. METHODS:: We conducted a national cohort study of 679,981 singleton births in Sweden in 1973-1979, followed up for all-cause and cause-specific mortality through 2008 (ages 29-36 years). RESULTS:: There were 10,656 deaths in 21.5 million person-years of follow-up. Among those still alive at the beginning of each age range, early-term birth relative to those born at 39-42 weeks was associated with increased mortality in the neonatal period (0-27 days: adjusted hazard ratio = 2.18 [95% confidence interval = 1.89-2.51]), postneonatal period (28-364 days: 1.66 [1.44-1.92]), early childhood (1-5 years: 1.29 [1.10-1.51]), and young adulthood (18-36 years: 1.14 [1.05-1.24]), but not in late childhood/adolescence (6-17 years: 0.97 [0.84-1.12]). In young adulthood, early-term birth was strongly associated with death from congenital anomalies and endocrine disorders, especially diabetes (2.89 [1.54-5.43]). CONCLUSIONS:: In this large national cohort study, early-term birth was independently associated with increased mortality in infancy, early childhood, and young adulthood. Lowest short-term and long-term mortality was among those born at 39-42 weeks.
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17.
  • Crump, Casey, et al. (author)
  • Exercise is medicine : Primary care counseling on aerobic fitness and muscle strengthening
  • 2019
  • In: Journal of the American Board of Family Medicine. - : American Board of Family Medicine (ABFM). - 1557-2625 .- 1558-7118. ; 32:1, s. 103-107
  • Journal article (peer-reviewed)abstract
    • Patient counseling on physical fitness remains underutilized in primary care, despite its clinical and cost effectiveness. Most counseling interventions have focused on aerobic activity and neglected another vital component of physical fitness, muscle strengthening, which has recently been shown to be independently protective against cardiometabolic diseases and premature mortality. This article reviews the latest scientific evidence and makes recommendations toward a more comprehensive approach for promoting physical fitness in primary care. Given the high prevalence and wide-ranging health impacts of physical inactivity, counseling on physical fitness should be a standard part of wellness promotion and disease prevention and treatment for all patients. Interventions that include muscle strengthening will have a significantly greater impact on health outcomes than those focused on aerobic fitness alone. Counseling to promote both aerobic fitness and muscle strengthening is indicated for all patients, irrespective of body weight, and should begin early in life and continue across the life course.
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18.
  • Crump, Casey, et al. (author)
  • Fetal Growth and Subsequent Maternal Risk of Colorectal Cancer.
  • 2015
  • In: Cancer Epidemiology Biomarkers & Prevention. - 1538-7755. ; 24:8, s. 1184-1189
  • Journal article (peer-reviewed)abstract
    • High birth weight has been associated with subsequent increased risk of breast cancer in the infant's mother, possibly related to maternal estrogen and growth factor pathways. However, its association with maternal risk of colorectal cancer, the third most common cancer among women, is unknown.
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19.
  • Crump, Casey, et al. (author)
  • Fetal growth and subsequent maternal risk of thyroid cancer.
  • 2016
  • In: International Journal of Cancer. - : Wiley. - 0020-7136. ; 138:5, s. 1085-1093
  • Journal article (peer-reviewed)abstract
    • Thyroid cancer has peak incidence among women of reproductive age, and growth factors, which have procarcinogenic properties, may play an important etiologic role. However, the association between fetal growth rate during a woman's pregnancy and her subsequent risk of thyroid cancer has not been previously examined. We conducted a national cohort study of 1,837,634 mothers who had a total of 3,588,497 live-births in Sweden in 1973-2008, followed up for thyroid cancer incidence through 2009. There were 2,202 mothers subsequently diagnosed with thyroid cancer in 36.8 million person-years of follow-up. After adjusting for maternal age, height, weight, smoking, and sociodemographic factors, high fetal growth (birth weight standardized for gestational age and sex) was associated with a subsequent increased risk of thyroid cancer in the mother (incidence rate ratio [IRR] per additional 1 standard deviation, 1.05; 95% CI, 1.01-1.09; P=0.02). Each 1,000 g increase in the infant's birth weight was associated with a 13% increase in the mother's subsequent risk of thyroid cancer (IRR, 1.13; 95% CI, 1.05-1.22; P=0.001). These findings appeared to involve both papillary and follicular subtypes, and did not vary significantly by the mother's height, weight, or smoking status. In this large national cohort study, high fetal growth during a woman's pregnancy was independently associated with a subsequent increased risk of her developing thyroid cancer. If confirmed, these findings suggest an important role of maternal growth factors in the development of thyroid cancer, and potentially may help facilitate the identification of high-risk subgroups of women. This article is protected by copyright. All rights reserved. © 2014 Wiley Periodicals, Inc.
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20.
  • Crump, Casey, et al. (author)
  • Gestational age at birth and mortality from infancy into mid-adulthood : a national cohort study
  • 2019
  • In: The Lancet Child and Adolescent Health. - 2352-4642. ; 3:6, s. 408-417
  • Journal article (peer-reviewed)abstract
    • Background: Breakthroughs in the treatment of preterm birth approximately 40 years ago have enabled a generation of preterm survivors to now reach mid-adulthood. Understanding their health sequelae is essential for guiding their long-term care. We did a study to examine preterm birth in relation to mortality into mid-adulthood. Methods: A national cohort study was done of all 4 296 814 singleton livebirths in Sweden between 1973 and 2015, who were followed up for mortality through Dec 31, 2017 (maximum age 45 years). Cox regression was used to examine gestational age at birth in relation to all-cause and cause-specific mortality, and cosibling analyses assessed for potential confounding by shared familial (genetic or environmental)factors. Findings: In 103·5 million person-years of follow-up, 43 916 (1·0%)deaths were reported. Gestational age at birth was inversely associated with mortality from infancy to mid-adulthood. Relative to full-term birth (39–41 weeks), the adjusted hazard ratios for mortality associated with gestational age at birth were: 66·14 (95% CI 63·09–69·34)for extremely preterm (22–27 weeks), 8·67 (8·32–9·03)for very preterm (28–33 weeks), 2·61 (2·52–2·71)for late preterm (34–36 weeks), and 1·34 (1·30–1·37)for early term (37–38 weeks), from birth to age 45 years; and 2·04 (0·92–4·55)for extremely preterm, 1·48 (1·17–1·87)for very preterm, 1·22 (1·07–1·39)for late preterm, and 1·16 (1·08–1·25)for early term, at ages 30–45 years. Preterm birth accounted for more deaths among males than females (additive interaction p<0·001). Multiple underlying causes were identified, including congenital anomalies; respiratory, endocrine, cardiovascular, and neurological diseases; cancer; and external causes. Cosibling analyses suggested that the observed associations were not due to shared genetic or environmental factors in families. Interpretation: Preterm and early term birth should be recognised as chronic conditions that require long-term follow-up for adverse health sequelae in adulthood. Funding: National Heart, Lung, and Blood Institute at the National Institutes of Health.
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21.
  • Crump, Casey, et al. (author)
  • Gestational Age at Birth and Mortality in Young Adulthood
  • 2011
  • In: JAMA: The Journal of the American Medical Association. - : American Medical Association (AMA). - 1538-3598. ; 306:11, s. 1233-1240
  • Journal article (peer-reviewed)abstract
    • Context Preterm birth is the leading cause of infant mortality in developed countries, but the association between gestational age at birth and mortality in adulthood remains unknown. Objective To examine the association between gestational age at birth and mortality in young adulthood. Design, Setting, and Participants National cohort study of 674 820 individuals born as singletons in Sweden in 1973 through 1979 who survived to age 1 year, including 27 979 born preterm (gestational age <37 weeks), followed up to 2008 (ages 29-36 years). Main Outcome Measures All-cause and cause-specific mortality. Results A total of 7095 deaths occurred in 20.8 million person-years of follow-up. Among individuals still alive at the beginning of each age range, a strong inverse association was found between gestational age at birth and mortality in early childhood (ages 1-5 years: adjusted hazard ratio [aHR] for each additional week of gestation, 0.92; 95% CI, 0.89-0.94; P<.001), which disappeared in late childhood (ages 6-12 years: aHR, 0.99; 95% CI, 0.95-1.03; P=.61) and adolescence (ages 13-17 years: aHR, 0.99; 95% CI, 0.95-1.03; P=.64) and then reappeared in young adulthood (ages 18-36 years: aHR, 0.96; 95% CI, 0.94-0.97; P<.001). In young adulthood, mortality rates (per 1000 person-years) by gestational age at birth were 0.94 for 22 to 27 weeks, 0.86 for 28 to 33 weeks, 0.65 for 34 to 36 weeks, 0.46 for 37 to 42 weeks (full-term), and 0.54 for 43 or more weeks. Preterm birth was associated with increased mortality in young adulthood even among individuals born late preterm (34-36 weeks, aHR, 1.31; 95% CI, 1.13-1.50; P<.001), relative to those born full-term. In young adulthood, gestational age at birth had the strongest inverse association with mortality from congenital anomalies and respiratory, endocrine, and cardiovascular disorders and was not associated with mortality from neurological disorders, cancer, or injury. Conclusion After excluding earlier deaths, low gestational age at birth was independently associated with increased mortality in early childhood and young adulthood. JAMA. 2011;306(11):1233-1240 www.jama.com
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22.
  • Crump, Casey, et al. (author)
  • Gestational Age at Birth and Mortality in Young Adulthood EDITORIAL COMMENT
  • 2012
  • In: Obstetrical and Gynecological Survey. - 0029-7828. ; 67:1, s. 12-13
  • Journal article (other academic/artistic)abstract
    • Preterm birth is associated with increased rates of neonatal and infant mortality. It has been hypothesized that gestational age at birth may also be associated with increased mortality rates in adulthood, but to date, no studies have demonstrated this relationship. This national cohort study investigated the association between gestational age at birth and mortality in young adulthood. Data obtained from the Swedish Birth Registry identified 678,528 individuals who were born as singletons between 1973 and 1979 and survived to age 1 year. Among this cohort, 674,820 were included in the final analysis. Of these, 27,979 (4.1%) born preterm (<37 weeks) were followed to age 29 to 36 years (up to 2008). The primary study outcome measures were all-cause and cause-specific mortality. Cox proportional hazards regression was used to estimate the association between gestational age at birth and mortality for 4 age categories: early childhood (age, 1-5 years), late childhood (age, 6-12 years), adolescence (age, 13-17 years), and young adulthood (age, 18-36 years). There were 7095 deaths reported in 20.8 million person-years of follow-up. A strong inverse association was found between gestational age at birth for 2 of the age categories and mortality among individuals still alive at the beginning of each age range. The adjusted hazard ratio [aHR] for each additional week of gestation in early childhood was 0.92 (95% confidence interval [CI], 0.89-0.94; P < 0.001). This inverse association disappeared in late childhood (aHR, 0.99; 95% CI, 0.95-1.03; P = 0.61) and adolescence (aHR, 0.99; 95% CI, 0.95-1.03; P = 0.64), and reappeared in young adulthood (aHR, 0.96; 95% CI, 0.94-0.97; P < 0.001). In young adulthood, the gestational age at birth was associated with mortality rates (per 1000 person-years) as follows: the aHR was 0.94 for 22 to 27 weeks, 0.86 for 28 to 33 weeks, 0.65 for 34 to 36 weeks, 0.46 for 37 to 42 weeks (full-term), and 0.54 for 43 or more weeks (P < 0.001 for all). Relative to individuals born full-term, preterm birth was associated with increased mortality in young adulthood even among individuals born late preterm (34-36 weeks); the aHR was 1.31, with a 95% CI of 1.13-1.50; P < 0.001). Moreover, gestational age at birth in young adulthood had the strongest inverse association with mortality from congenital anomalies, as well as respiratory, endocrine, and cardiovascular disorders, and it had no association with mortality from neurological disorders, cancer, or injury.
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23.
  • Crump, Casey, et al. (author)
  • Gestational age at birth and risk of allergic rhinitis in young adulthood
  • 2011
  • In: Journal of Allergy and Clinical Immunology. - : Elsevier BV. - 1097-6825 .- 0091-6749. ; 127:5, s. 1173-1179
  • Journal article (peer-reviewed)abstract
    • Background: Previous studies of the association between gestational age or birth weight and allergic rhinitis in later life have had various limitations, including the inability to estimate risk among subjects born extremely preterm or to examine specific contributions of gestational age and fetal growth. Objective: We sought to determine whether gestational age at birth independent of fetal growth is associated with allergic rhinitis medication prescription in a national cohort of young adults. Methods: We conducted a national cohort study of 630,090 infants born in Sweden from 1973 through 1979 including 27,953 born preterm (<37 weeks) and followed for prescription of nasal corticosteroids and oral antihistamines in 2005-2009 (age, 25.5-37.0 years). Medication data were obtained from all outpatient and inpatient pharmacies throughout Sweden. Results: The overall prevalence of nasal corticosteroid and oral antihistamine prescription was 16.3% and 16.8%, respectively, which is similar to the reported prevalence of allergic rhinitis in this population. Low gestational age at birth was associated with a decreased risk of nasal corticosteroid and oral antihistamine prescription in young adulthood after adjusting for fetal growth and other potential confounders. For subjects born extremely preterm (23-28 weeks), adjusted odds ratios were 0.70 (95% CI, 0.51-0.96) for nasal corticosteroid prescription and 0.45 (95% CI, 0.27-0.76) for both nasal corticosteroid and oral antihistamine prescription relative to those born at full term. Conclusion: These findings suggest that low gestational age at birth independent of fetal growth is associated with a decreased risk of allergic rhinitis in young adulthood, possibly because of a protective effect of earlier exposure to pathogens. (J Allergy Clin Immunol 2011;127:1173-9.)
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24.
  • Crump, Casey, et al. (author)
  • Gestational Age at Birth and Risk of Gastric Acid-Related Disorders in Young Adulthood
  • 2012
  • In: Annals of Epidemiology. - : Elsevier BV. - 1047-2797. ; 22:4, s. 233-238
  • Journal article (peer-reviewed)abstract
    • PURPOSE: Preterm birth is associated with gastric acid-related disorders in infancy, but no investigators have examined this association beyond early childhood. We used antisecretory medication data to explore whether preterm birth is associated with gastric acid-related disorders in young adulthood. METHODS: We conducted a national cohort study of 626,811 individuals born in Sweden in 1973 to 1979, followed up for antisecretory (proton pump inhibitor and H2-receptor antagonist) medication prescriptions from all outpatient and inpatient pharmacies nationwide from 2005 to 2009 (ages 25.5-37.0 years). We excluded individuals with congenital anomalies, and examined potential confounding by other comorbidities identified on the basis of oral anti-inflammatory or corticosteroid medication prescription. RESULTS: Gestational age at birth was inversely associated with antisecretory medication prescription in young adulthood. Adjusted odds ratios for >= 1 antisecretory medication prescription/year were 3.38 (95% confidence interval [95% CI], 1.73-6.62) for individuals born at 22-27 weeks, 1.38 (95% CI, 1.19-1.60) for those born at 28-34 weeks, and 1.19 (95% CI, 1.06-1.32) for those born at 35-36 weeks, relative to those born full-term (37-42 weeks). Exclusion of individuals who were prescribed oral anti-inflammatory or corticosteroid medications (>= 1/year) had little effect on these results. CONCLUSIONS: These findings suggest that low gestational age at birth may be independently associated with an increased risk of gastric acid-related disorders in young adulthood. Ann Epidemiol 2012;22:233-238. (C) 2012 Elsevier Inc. All rights reserved.
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25.
  • Crump, Casey, et al. (author)
  • Gestational age at birth and risk of testicular cancer
  • 2012
  • In: International Journal of Cancer. - : Wiley. - 0020-7136. ; 131:2, s. 446-451
  • Journal article (peer-reviewed)abstract
    • Most testicular germ cell tumors originate from carcinoma in situ cells in fetal life, possibly related to sex hormone imbalances in early pregnancy. Previous studies of association between gestational age at birth and testicular cancer have yielded discrepant results and have not examined extreme preterm birth. Our objective was to determine whether low gestational age at birth is independently associated with testicular cancer in later life. We conducted a national cohort study of 354,860 men born in Sweden in 19731979, including 19,214 born preterm (gestational age < 37 weeks) of whom 1,279 were born extremely preterm (2229 weeks), followed for testicular cancer incidence through 2008. A total of 767 testicular cancers (296 seminomas and 471 nonseminomatous germ cell tumors) were identified in 11.2 million person-years of follow-up. Extreme preterm birth was associated with an increased risk of testicular cancer (hazard ratio = 3.95; 95% confidence interval = 1.679.34) after adjusting for other perinatal factors, family history of testicular cancer and cryptorchidism. Only five cases (three seminomas and two nonseminomas) occurred among men born extremely preterm, limiting the precision of risk estimates. No association was found between later preterm birth, post-term birth or low or high fetal growth and testicular cancer. These findings suggest that extreme but not later preterm birth may be independently associated with testicular cancer in later life. They are based on a small number of cases and will need confirmation in other large cohorts. Elucidation of the key prenatal etiologic factors may potentially lead to preventive interventions in early life.
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26.
  • Crump, Casey, et al. (author)
  • Health care utilization prior to suicide in adults with drug use disorders
  • 2021
  • In: Journal of Psychiatric Research. - : Elsevier BV. - 0022-3956. ; 135, s. 230-236
  • Journal article (peer-reviewed)abstract
    • Drug use disorders (DUD) are associated with psychiatric illness and increased risks of suicide. We examined health care utilization prior to suicide in adults with DUD, which may reveal opportunities to prevent suicide in this high-risk population. A national cohort study was conducted of all 6,947,191 adults in Sweden, including 166,682 (2.4%) with DUD, who were followed up for suicide during 2002–2015. A nested case-control design examined health care utilization among persons with DUD who died by suicide and 10:1 age- and sex-matched controls from the general population. In 86.7 million person-years of follow-up, 15,662 (0.2%) persons died by suicide, including 1946 (1.2%) persons with DUD. Unadjusted and adjusted relative risks of suicide associated with DUD were 11.03 (95% CI, 10.62–11.46) and 2.84 (2.68–3.00), respectively. 30.4% and 52.3% of DUD cases who died by suicide had a health care encounter within 2 weeks or 3 months before the index date, respectively, compared with 5.9% and 24.3% of controls (unadjusted prevalence ratio and difference, <2 weeks: 5.20 [95% CI, 4.76–5.67] and 24.6 percentage points [22.5–26.6]; <3 months: 2.15 [2.05–2.26] and 27.9 [25.6–30.2]). However, after adjusting for psychiatric comorbidities, these differences were much attenuated. Among DUD cases, 72.5% of last encounters within 2 weeks before suicide were in outpatient clinics, mostly for non-psychiatric diagnoses. In this large national cohort, suicide among adults with DUD was often shortly preceded by outpatient clinic encounters. Clinical encounters in these settings are important opportunities to identify suicidality and intervene accordingly in patients with DUD.
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27.
  • Crump, Casey, et al. (author)
  • Healthcare utilisation prior to suicide in persons with alcohol use disorder : National cohort and nested case-control study
  • 2020
  • In: British Journal of Psychiatry. - : Royal College of Psychiatrists. - 0007-1250 .- 1472-1465. ; 217:6, s. 710-716
  • Journal article (peer-reviewed)abstract
    • Background Alcohol use disorder (AUD) is common and associated with increased risk of suicide. Aims To examine healthcare utilisation prior to suicide in persons with AUD in a large population-based cohort, which may reveal opportunities for prevention. Method A national cohort study was conducted of 6 947 191 adults in Sweden in 2002, including 256 647 (3.7%) with AUD, with follow-up for suicide through 2015. A nested case-control design examined healthcare utilisation among people with AUD who died by suicide and 10:1 age- and gender-matched controls. Results In 86.7 million person-years of follow-up, 15 662 (0.2%) persons died by suicide, including 2601 (1.0%) with AUD. Unadjusted and adjusted relative risks for suicide associated with AUD were 8.15 (95% CI 7.86-8.46) and 2.22 (95% CI 2.11-2.34). Of the people with AUD who died by suicide, 39.7% and 75.6% had a healthcare encounter <2 weeks or <3 months before the index date respectively, compared with 6.3% and 25.4% of controls (adjusted prevalence ratio (PR) and difference (PD), <2 weeks: PR = 3.86, 95% CI 3.50-4.25, PD = 26.4, 95% CI 24.2-28.6; <3 months: PR = 2.03, 95% CI 1.94-2.12, PD = 34.9, 95% CI 32.6-37.1). AUD accounted for more healthcare encounters within 2 weeks of suicide among men than women (P = 0.01). Of last encounters, 48.1% were in primary care and 28.9% were in specialty out-patient clinics, mostly for non-psychiatric diagnoses. Conclusions Suicide among persons with AUD is often shortly preceded by healthcare encounters in primary care or specialty out-patient clinics. Encounters in these settings are important opportunities to identify active suicidality and intervene accordingly in patients with AUD.
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28.
  • Crump, Casey, et al. (author)
  • Interactive Effects of Aerobic Fitness, Strength, and Obesity on Mortality in Men
  • 2017
  • In: American Journal of Preventive Medicine. - : Elsevier BV. - 0749-3797. ; 52:3, s. 353-361
  • Journal article (peer-reviewed)abstract
    • Introduction: Low aerobic fitness, low muscular strength, and obesity have been associated with premature mortality, but their interactive effects are unknown. This study examined interactions among these common, modifiable factors, to help inform more-effective preventive interventions. Methods: This national cohort study included all 1,547,478 military conscripts in Sweden during 1969-1997 (97%-98% of all men aged 18 years each year). Aerobic fitness, muscular strength, and BMI measurements were examined in relation to all-cause and cardiovascular mortality through 2012 (maximum age, 62 years). Data were collected/analyzed in 2015-2016. Results: Low aerobic fitness, low muscular strength, and obesity at age 18 years were independently associated with higher all-cause and cardiovascular mortality in adulthood. The combination of low aerobic fitness and muscular strength (lowest versus highest tertiles) was associated with twofold all-cause mortality (adjusted hazard ratio=2.01; 95% CI=1.93, 2.08;. p<0.001; mortality rates per 100,000 person years, 247.2 vs 73.8), and 2.6-fold cardiovascular mortality (2.63; 95% CI=2.38, 2.91;. p<0.001; 43.9 vs 8.3). These factors also had positive additive and multiplicative interactions in relation to all-cause mortality (their combined effect exceeded the sum or product of their separate effects;. p<0.001), and were associated with higher mortality even among men with normal BMI. Conclusions: Low aerobic fitness, low muscular strength, and obesity at age 18 years were associated with increased mortality in adulthood, with interactive effects between aerobic fitness and muscular strength. Preventive interventions should begin early in life and include both aerobic fitness and muscular strength, even among those with normal BMI.
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29.
  • Crump, Casey, et al. (author)
  • Interactive effects of physical fitness and body mass index on risk of stroke : A national cohort study
  • 2016
  • In: International Journal of Stroke. - : SAGE Publications. - 1747-4949 .- 1747-4930. ; 11:6, s. 683-694
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: High body mass index (BMI) and low physical fitness are risk factors for stroke, but their interactive effects are unknown. Elucidation of interactions between these modifiable risk factors can help inform preventive interventions in susceptible subgroups.METHODS: National cohort study of all 1,547,294 military conscripts in Sweden during 1969-1997 (97-98% of all 18-year-old males). Standardized aerobic capacity, muscular strength, and body mass index measurements were examined in relation to stroke identified from inpatient and outpatient diagnoses through 2012 (maximum age 62 years).RESULTS: Sixteen thousand nine hundred seventy-nine men were diagnosed with stroke in 39.7 million person-years of follow-up. High body mass index, low aerobic fitness, and (less strongly) low muscular fitness were associated with higher risk of any stroke, ischemic stroke, and intracerebral hemorrhage, independently of family history and sociodemographic factors. High body mass index (overweight/obese vs. normal) and low aerobic capacity (lowest vs. highest tertile) had similar effect magnitudes, and their combination was associated with highest stroke risk (incidence rate ratio, 2.36; 95% CI, 2.14-2.60; P < 0.001). Aerobic capacity and muscular strength had a positive additive and multiplicative interaction (P < 0.001), indicating that low aerobic capacity accounted for more strokes among men with low compared with high muscular strength.CONCLUSIONS: High body mass index and low aerobic capacity in late adolescence are associated with increased risk of stroke in adulthood. Low aerobic capacity and low muscular strength also have a synergistic effect on stroke risk. These findings suggest that preventive interventions should include weight control and aerobic fitness early in life, and muscular fitness especially among those with low aerobic capacity.
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30.
  • Crump, Casey, et al. (author)
  • Interactive Effects of Physical Fitness and Body Mass Index on the Risk of Hypertension.
  • 2016
  • In: JAMA Internal Medicine. - : American Medical Association (AMA). - 2168-6114 .- 2168-6106. ; 176:2, s. 210-216
  • Journal article (peer-reviewed)abstract
    • High body mass index (BMI) and low physical fitness are risk factors for hypertension, but their interactive effects are unknown. Elucidation of interactions between these modifiable risk factors may help inform more effective interventions in susceptible subgroups.
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31.
  • Crump, Casey, et al. (author)
  • Low stress resilience in late adolescence and risk of hypertension in adulthood.
  • 2016
  • In: Heart. - : BMJ. - 1355-6037 .- 1468-201X.
  • Journal article (peer-reviewed)abstract
    • Greater blood pressure reactivity to psychological stress has been associated with higher risk of developing hypertension. We hypothesised that low stress resilience based on psychological assessment early in life is associated with hypertension in adulthood.
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32.
  • Crump, Casey, et al. (author)
  • Mental disorders and vulnerability to homicidal death: Swedish nationwide cohort study
  • 2013
  • In: BMJ: British Medical Journal. - : BMJ. - 1756-1833. ; 346, s. 557-557
  • Journal article (peer-reviewed)abstract
    • Objective To determine the risk of people with mental disorders being victims of homicide. Design National cohort study. Setting Sweden. Participants Entire adult population (n=7 253 516). Main outcome measures Homicidal death during eight years of follow-up (2001-08); hazard ratios for the association between mental disorders and homicidal death, with adjustment for sociodemographic confounders; potential modifying effect of comorbid substance use. Results 615 homicidal deaths occurred in 54.4 million person years of follow-up. Mortality rates due to homicide (per 100 000 person years) were 2.8 among people with mental disorders compared with 1.1 in the general population. After adjustment for sociodemographic confounders, any mental disorder was associated with a 4.9-fold (95% confidence interval 4.0 to 6.0) risk of homicidal death, relative to people without mental disorders. Strong associations were found irrespective of age, sex, or other sociodemographic characteristics. Although the risk of homicidal death was highest among people with substance use disorders (approximately ninefold), the risk was also increased among those with personality disorders (3.2-fold), depression (2.6-fold), anxiety disorders (2.2-fold), or schizophrenia (1.8-fold) and did not seem to be explained by comorbid substance use. Sociodemographic risk factors included male sex, being unmarried, and low socioeconomic status. Conclusions In this large cohort study, people with mental disorders, including those with substance use disorders, personality disorders, depression, anxiety disorders, or schizophrenia, had greatly increased risks of homicidal death. Interventions to reduce violent death among people with mental disorders should tackle victimisation and homicidal death in addition to suicide and accidents, which share common risk factors.
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33.
  • Crump, Casey, et al. (author)
  • Mortality in persons with mental disorders is substantially overestimated using inpatient psychiatric diagnoses
  • 2013
  • In: Journal of Psychiatric Research. - : Elsevier BV. - 1879-1379 .- 0022-3956. ; 47:10, s. 1298-1303
  • Journal article (peer-reviewed)abstract
    • Mental disorders are associated with premature mortality, and the magnitudes of risk have commonly been estimated using hospital data. However, psychiatric patients who are hospitalized have more severe illness and do not adequately represent mental disorders in the general population. We conducted a national cohort study using outpatient and inpatient diagnoses for the entire Swedish adult population (N = 7,253,516) to examine the extent to which mortality risks are overestimated using inpatient diagnoses only. Outcomes were all-cause and suicide mortality during 8 years of follow-up (2001-2008). There were 377,339 (5.2%) persons with any inpatient psychiatric diagnosis, vs. 680,596 (9.4%) with any inpatient or outpatient diagnosis, hence 44.6% of diagnoses were missed using inpatient data only. When including and accounting for prevalent psychiatric cases, all-cause mortality risk among persons with any mental disorder was overestimated by 153% using only inpatient diagnoses (adjusted hazard ratio [aHR], 5.89; 95% Cl, 5.85-5.92) vs. both inpatient and outpatient diagnoses (aHR, 5.11; 95% Cl, 5.08-5.14). Suicide risk was overestimated by 18.5% (aHRs, 23.91 vs. 20.18), but this varied widely by specific disorders, from 4.4% for substance use to 49.1% for anxiety disorders. The sole use of inpatient diagnoses resulted in even greater overestimation of all-cause or suicide mortality risks when prevalent cases were unidentified (similar to 20-30%) or excluded (similar to 25-40%). However, different methods for handling prevalent cases resulted in only modest variation in risk estimates when using both inpatient and outpatient diagnoses. These findings have important implications for the interpretation of hospital-based studies and the design of future studies. (C) 2013 Elsevier Ltd. All rights reserved.
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34.
  • Crump, Casey, et al. (author)
  • Neighborhood Deprivation and Psychiatric Medication Prescription: A Swedish National Multilevel Study
  • 2011
  • In: Annals of Epidemiology. - : Elsevier BV. - 1047-2797. ; 21:4, s. 231-237
  • Journal article (peer-reviewed)abstract
    • PURPOSE: Previous studies of neighborhood deprivation and mental disorders have yielded mixed results, possibly because they were based on different substrata of the population. We conducted a national multilevel study to determine whether neighborhood deprivation is independently associated with psychiatric medication prescription in a national population. METHODS: Nationwide outpatient and inpatient psychiatric medication data were analyzed for all Swedish adults (N = 6,998,075) after 2.5 years of follow-up. Multilevel logistic regression was used to estimate the association between neighborhood deprivation (index of education, income, unemployment, and welfare assistance) and prescription of psychiatric medications (antipsychotics, antidepressants, anxiolytics, or hypnotics/sedatives), after adjusting for broadly measured individual-level sociodemographic characteristics. RESULTS: For each psychiatric medication class, a monotonic trend of increasing prescription was observed by increasing level of neighborhood deprivation. The strongest associations were found for antipsychotics and anxiolytics, with adjusted odds ratios of 1.40 (95% confidence interval [CI], 1.36-1.44) and 1.24 (95% CI, 1.22-1.27), respectively, comparing the highest-to the lowest-deprivation neighborhood quintiles. CONCLUSIONS: These findings suggest that neighborhood deprivation is associated with psychiatric medication prescription independent of individual-level sociodemographic characteristics. Further research is needed to elucidate the mechanisms by which neighborhood deprivation may affect mental health and to identify the most susceptible groups in the population. Ann Epidemiol 2011;21:231-237. (C) 2011 Elsevier Inc. All rights reserved.
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35.
  • Crump, Casey, et al. (author)
  • Perinatal and Familial Risk Factors for Acute Lymphoblastic Leukemia in a Swedish National Cohort
  • 2015
  • In: Cancer. - : Wiley. - 1097-0142 .- 0008-543X. ; 121:7, s. 1040-1047
  • Journal article (peer-reviewed)abstract
    • BACKGROUNDPerinatal factors including high birth weight have been found to be associated with acute lymphoblastic leukemia (ALL) in case-control studies. However, to the best of our knowledge, these findings have seldom been examined in large population-based cohort studies, and the specific contributions of gestational age and fetal growth remain unknown. METHODSThe authors conducted a national cohort study of 3,569,333 individuals without Down syndrome who were born in Sweden between 1973 and 2008 and followed for the incidence of ALL through 2010 (maximum age, 38 years) to examine perinatal and familial risk factors. RESULTSThere were 1960 ALL cases with 69.7 million person-years of follow-up. After adjusting for potential confounders, risk factors for ALL included high fetal growth (incidence rate ratio [IRR] per additional 1 standard deviation, 1.07; 95% confidence interval [95% CI], 1.02-1.11 [P =.002]; and IRR for large vs appropriate for gestational age, 1.22; 95% CI, 1.06-1.40 [P =.005]), first-degree family history of ALL (IRR, 7.41; 95% CI, 4.60-11.95 [P<.001]), male sex (IRR, 1.20; 95% CI, 1.10-1.31 [P<.001]), and parental country of birth (IRR for both parents born in Sweden vs other countries, 1.13; 95% CI, 1.00-1.27 [P =.045]). These risk factors did not appear to vary by patient age at the time of diagnosis of ALL. Gestational age at birth, season of birth, birth order, multiple birth, parental age, and parental education level were not found to be associated with ALL. CONCLUSIONSIn this large cohort study, high fetal growth was found to be associated with an increased risk of ALL in childhood through young adulthood, independent of gestational age at birth, suggesting that growth factor pathways may play an important long-term role in the etiology of ALL. Cancer 2015;121:1040-1047. (c) 2014 American Cancer Society. The authors conducted what, to their knowledge, is the largest population-based cohort study to date to examine perinatal and familial risk factors for acute lymphoblastic leukemia (ALL) among approximately 3.5 million individuals born in Sweden between 1973 and 2008. High fetal growth was found to be associated with an increased risk of ALL in childhood through young adulthood, independent of gestational age at birth, suggesting that growth factor pathways may play an important long-term role in the etiology of ALL.
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36.
  • Crump, Casey, et al. (author)
  • Perinatal And Familial Risk Factors For Brain Tumors in Childhood Through Young Adulthood.
  • 2015
  • In: Cancer Research. - 1538-7445. ; 75:3, s. 576-583
  • Journal article (peer-reviewed)abstract
    • Perinatal factors including high birth weight have been associated with childhood brain tumors in case-control studies. However, the specific contributions of gestational age and fetal growth remain unknown, and these issues have never been examined in large cohort studies with follow-up into adulthood. We conducted a national cohort study of 3,571,574 persons born in Sweden in 1973-2008, followed up for brain tumor incidence through 2010 (maximum age 38 years) to examine perinatal and familial risk factors. There were 2,809 brain tumors in 69.7 million person-years of follow-up. After adjusting for potential confounders, significant risk factors for brain tumors included high fetal growth (incidence rate ratio [IRR] per additional 1 standard deviation, 1.04; 95% CI, 1.01-1.08, P=0.02), first-degree family history of a brain tumor (IRR, 2.43; 95% CI, 1.86-3.18, P<0.001), parental country of birth (IRR for both parents born in Sweden vs. other countries, 1.21; 95% CI, 1.09-1.35, P<0.001), and high maternal education level (Ptrend=0.01). These risk factors did not vary by age at diagnosis. The association with high fetal growth appeared to involve pilocytic astrocytomas, but not other astrocytomas, medulloblastomas, or ependymomas. Gestational age at birth, birth order, multiple birth, and parental age were not associated with brain tumors. In this large cohort study, high fetal growth was associated with an increased risk of brain tumors (particularly pilocytic astrocytomas) independently of gestational age, not only in childhood but also into young adulthood, suggesting that growth factor pathways may play an important long-term role in the etiology of certain brain tumor subtypes.
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37.
  • Crump, Casey, et al. (author)
  • Perinatal and Family Risk Factors for Hodgkin Lymphoma in Childhood Through Young Adulthood
  • 2012
  • In: American Journal of Epidemiology. - : Oxford University Press (OUP). - 0002-9262 .- 1476-6256. ; 176:12, s. 1147-1158
  • Journal article (peer-reviewed)abstract
    • The incidence of Hodgkin lymphoma has increased among adolescents and young adults in recent decades, but the relevant risk factors in early life are still unknown. A national cohort study was conducted of 3,571,574 individuals born in Sweden in 19732008 and followed up for Hodgkin lymphoma incidence through 2009, to examine perinatal and family risk factors for Hodgkin lymphoma in childhood through young adulthood (ages 037 years). There were 943 Hodgkin lymphoma cases identified in 66.3 million person-years of follow-up. High fetal growth was associated with an increased risk of Hodgkin lymphoma after adjustment for gestational age at birth and other potential confounders (P-trend 0.005). Family history of Hodgkin lymphoma in a sibling or parent also was strongly associated with an increased risk, with adjusted hazard ratios 8.83 (95 confidence interval: 3.67, 21.30) and 7.19 (95 confidence interval: 3.58, 14.44), respectively. No association was found between gestational age at birth, birth order, twinning, parental age, or parental education and Hodgkin lymphoma. These findings did not vary by age at Hodgkin lymphoma diagnosis. Similar associations were found for nodular sclerosis and mixed cellularity subtypes. These findings suggest that perinatal factors including possible growth factor pathways may contribute to the risk of Hodgkin lymphoma in childhood through young adulthood.
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38.
  • Crump, Casey, et al. (author)
  • Perinatal and Family Risk Factors for Non-Hodgkin Lymphoma in Early Life: A Swedish National Cohort Study.
  • 2012
  • In: Journal of the National Cancer Institute. - : Oxford University Press (OUP). - 1460-2105 .- 0027-8874. ; 104:12, s. 923-930
  • Journal article (peer-reviewed)abstract
    • Background: The incidence of non-Hodgkin lymphoma (NHL) in early life has increased in recent decades, but the relevant risk factors remain largely unknown. We examined perinatal and family risk factors for NHL in childhood through young adulthood. Methods: We conducted a national cohort study of 3 571 574 individuals born in Sweden in 1973-2008 who were followed for incidence of NHL through 2009 (ages 0-37 years). Detailed information on perinatal and family characteristics and NHL diagnoses were obtained from national birth and cancer registries. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between perinatal and family variables and NHL; P values are from two-sided tests. Results: There were 936 NHL case patients identified in 66.3 million person-years of follow-up. Independent risk factors for NHL included family history of NHL in either a sibling (adjusted HR = 9.84; 95% CI = 2.46 to 39.41; P = .001) or parent (adjusted HR = 2.36; 95% CI = 1.27 to 4.38; P = .007); high fetal growth (for ≥2 SDs relative to 0 to <1 SD from the mean: adjusted HR = 1.64; 95% CI = 1.19 to 2.25; P = .002); older maternal age (adjusted HR for each 5-year increment = 1.11; 95% CI = 1.04 to 1.19; P(trend) = .004); low birth order (adjusted HR for each increment of one birth = 0.91; 95% CI = 0.84 to 0.99; P(trend) = .02); and male sex (adjusted HR = 1.58; 95% CI = 1.38 to 1.80; P < .001). Male sex was associated with onset of NHL before 15 years of age but not with later-onset NHL, whereas the other risk factors did not vary by age at diagnosis. No association was found between gestational age at birth, twinning, paternal age, or parental education and NHL. Conclusion: In this large national cohort study, family history of NHL, high fetal growth, older maternal age, low birth order, and male sex were independent risk factors for NHL in early life.
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39.
  • Crump, Casey, et al. (author)
  • Perinatal risk factors for acute myeloid leukemia
  • 2015
  • In: European Journal of Epidemiology. - : Springer Science and Business Media LLC. - 1573-7284 .- 0393-2990. ; 30:12, s. 1277-1285
  • Journal article (peer-reviewed)abstract
    • Infectious etiologies have been hypothesized for acute leukemias because of their high incidence in early childhood, but have seldom been examined for acute myeloid leukemia (AML). We conducted the first large cohort study to examine perinatal factors including season of birth, a proxy for perinatal infectious exposures, and risk of AML in childhood through young adulthood. A national cohort of 3,569,333 persons without Down syndrome who were born in Sweden in 1973-2008 were followed up for AML incidence through 2010 (maximum age 38 years). There were 315 AML cases in 69.7 million person-years of follow-up. We found a sinusoidal pattern in AML risk by season of birth (P < 0.001), with peak risk among persons born in winter. Relative to persons born in summer (June-August), incidence rate ratios for AML were 1.72 (95 % CI 1.25-2.38; P = 0.001) for winter (December-February), 1.37 (95 % CI 0.99-1.90; P = 0.06) for spring (March-May), and 1.27 (95 % CI 0.90-1.80; P = 0.17) for fall (September-November). Other risk factors for AML included high fetal growth, high gestational age at birth, and low maternal education level. These findings did not vary by sex or age at diagnosis. Sex, birth order, parental age, and parental country of birth were not associated with AML. In this large cohort study, birth in winter was associated with increased risk of AML in childhood through young adulthood, possibly related to immunologic effects of early infectious exposures compared with summer birth. These findings warrant further investigation of the role of seasonally varying perinatal exposures in the etiology of AML.
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40.
  • Crump, Casey, et al. (author)
  • Perinatal risk factors for Wilms tumor in a Swedish national cohort
  • 2014
  • In: European Journal of Epidemiology. - : Springer Science and Business Media LLC. - 1573-7284 .- 0393-2990. ; 29:3, s. 191-197
  • Journal article (peer-reviewed)abstract
    • Perinatal risk factors including high birth weight have been associated with Wilms tumor in case-control studies. However, these findings have seldom been examined in large cohort studies, and the specific contributions of gestational age at birth and fetal growth remain unknown. We conducted the largest population-based cohort study to date consisting of 3,571,574 persons born in Sweden in 1973-2008, followed up for Wilms tumor incidence through 2009 to examine perinatal risk factors. There were 443 Wilms tumor cases identified in 66.3 million person-years of follow-up. After adjusting for gestational age and other perinatal factors, high fetal growth was associated with increased risk of Wilms tumor among girls (hazard ratio per 1 standard deviation (SD), 1.36; 95 % CI 1.20-1.54; P < 0.001), but not boys (1.10; 95 % CI 0.97-1.25; P = 0.14) (P (interaction) = 0.02). Among girls, high fetal growth was associated with disease onset before age 5 years (odds ratio per 1 SD, 1.47; 95 % CI 1.28-1.69; P < 0.001), but not beyond (1.00; 95 % CI 0.76-1.31; P = 0.99). No clear associations were found for gestational age at birth or other perinatal factors. In this large cohort study, high fetal growth was associated with Wilms tumor before age 5 years among girls. These findings suggest that early-life growth factor pathways for Wilms tumor may be more common among girls than boys. Further elucidation of these mechanisms may reveal better targets for prevention or treatment of specific subtypes of Wilms tumor.
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41.
  • Crump, Casey, et al. (author)
  • Physical fitness among swedish military conscripts and long-term risk for type 2 diabetes mellitus a cohort study
  • 2016
  • In: Annals of Internal Medicine. - 0003-4819. ; 164:9, s. 577-584
  • Journal article (peer-reviewed)abstract
    • Background: Early-life physical fitness has rarely been examined in relation to type 2 diabetes mellitus (DM) in adulthood because of the lengthy follow-up required. Elucidation of modifiable risk factors at young ages may help facilitate earlier and more effective interventions. Objective: To examine aerobic capacity and muscle strength at age 18 years in relation to risk for type 2 DM in adulthood. Design: National cohort study. Setting: Sweden. Participants: 1 534 425 military conscripts from 1969 to 1997 (97% to 98% of all men aged 18 years nationwide) without prior type 2 DM. Measurements: Aerobic capacity and muscle strength (measured in watts and newtons per kilogram of body weight, respectively) were examined in relation to type 2 DM identified from outpatient and inpatient diagnoses from 1987 to 2012 (maximum age, 62 years). Results: 34 008 men were diagnosed with type 2 DM in 39.4 million person-years of follow-up. Low aerobic capacity and muscle strength were independently associated with increased risk for type 2 DM. The absolute difference in cumulative incidence of type 2 DM between the lowest and highest tertiles of both aerobic capacity and strength was 0.22% at 20 years of follow-up (95% CI, 0.20% to 0.25%), 0.76% at 30 years (CI, 0.71% to 0.81%), and 3.97% at 40 years (CI, 3.87% to 4.06%). Overall, the combination of low aerobic capacity and muscle strength was associated with a 3-fold risk for type 2 DM(adjusted hazard ratio, 3.07 [CI, 2.88 to 3.27]; P <0.001), with a positive additive interaction (P <0.001). These associations were seen even among men with normal body mass index. Limitation: This cohort did not include women and did not measure physical fitness at older ages. Conclusion: In this large cohort of Swedish male military conscripts, low aerobic capacity and muscle strength at age 18 years were associated with increased long-term risk for type 2 DM, even among those with normal body mass index. Primary Funding Source: National Institutes of Health.
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42.
  • Crump, Casey, et al. (author)
  • Pre-term delivery and long-term risk of heart failure in women : a national cohort and co-sibling study
  • 2022
  • In: European Heart Journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X. ; 43:9, s. 895-904
  • Journal article (peer-reviewed)abstract
    • AIMS: Women who deliver pre-term have higher future risks of hypertension and ischaemic heart disease, but long-term risks of heart failure (HF) are unknown. We examined these risks in a large national cohort.METHODS AND RESULTS: All 2 201 284 women with a singleton delivery in Sweden during 1973-2015 were followed up for inpatient or outpatient HF diagnoses through 2015. Cox regression was used to compute hazard ratios (HRs) for HF associated with pregnancy duration, adjusting for other maternal factors. Co-sibling analyses assessed for confounding by shared familial (genetic and/or environmental) factors. In 48.2 million person-years of follow-up, 19 922 women were diagnosed with HF (median age: 60.7 years). Within 10 years after delivery, the adjusted HR was 2.96 [95% confidence interval (CI): 2.48-3.53] for HF associated with pre-term (gestational age: <37 weeks) compared with full-term (39-41 weeks) delivery. Stratified HRs were 4.27 (2.54-7.17) for extremely pre-term (22-27 weeks), 3.39 (2.57-4.48) for moderately pre-term (28-33 weeks), 2.70 (2.19-3.32) for late pre-term (34-36 weeks), and 1.70 (1.45-1.98) for early term (37-38 weeks). These HRs declined but remained elevated at 10-19 years (pre-term vs. full term: HR: 2.19; 95% CI: 1.94-2.46), 20-29 years (1.80; 1.67-1.95), and 30-43 years (1.56; 1.47-1.66) after delivery, and were not explained by shared familial factors.CONCLUSION: Pre-term and early term delivery were associated with markedly increased future hazards for HF, which persisted after adjusting for other maternal and familial factors and remained elevated 40 years later. Pre-term and early-term delivery should be recognized as risk factors for HF across the life course.KEY QUESTION: What are the long-term hazards for heart failure (HF) across the life course in women who deliver preterm?KEY FINDING: Preterm and early term delivery were associated with ∼3- and 1.7-fold adjusted hazards for HF in the next 10 years vs. full-term delivery. These hazards declined but remained elevated 40 years later, and were not explained by shared familial factors.TAKE HOME MESSAGE: Preterm and early term delivery were associated with increased future hazards for HF, which persisted for 40 years after adjusting for other maternal and familial factors. Preterm and early term delivery should be recognized as lifelong risk factors for HF.
  •  
43.
  • Crump, Casey, et al. (author)
  • Pre-Term Delivery and Risk of Ischemic Heart Disease in Women
  • 2020
  • In: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097. ; 76:1, s. 57-67
  • Journal article (peer-reviewed)abstract
    • Background: Women who deliver pre-term have been reported to have increased future risks of cardiometabolic disorders. However, their long-term risks of ischemic heart disease (IHD) and whether such risks are due to shared familial factors are unclear. A better understanding of these risks may help improve long-term clinical follow-up and interventions to prevent IHD in women. Objectives: The purpose of this study was to determine the long-term risks of IHD in women by pregnancy duration. Methods: A national cohort study was conducted of all 2,189,190 women with a singleton delivery in Sweden from 1973 to 2015, who were followed up for IHD through the end of 2015. Cox regression was used to compute adjusted hazard ratios (aHRs) for IHD associated with pregnancy duration, and cosibling analyses assessed the influence of shared familial (genetic and/or environmental) factors. Results: In 47.5 million person-years of follow-up, 49,955 (2.3%) women were diagnosed with IHD. In the 10 years following delivery, the aHR for IHD associated with pre-term delivery (<37 weeks) was 2.47 (95% confidence interval [CI]: 2.16 to 2.82), and further stratified was 4.04 (95% CI: 2.69 to 6.08) for extremely pre-term (22 to 27 weeks), 2.62 (95% CI: 2.09 to 3.29) for very pre-term (28 to 33 weeks), 2.30 (95% CI: 1.97 to 2.70) for late pre-term (34 to 36 weeks), and 1.47 (95% CI: 1.30 to 1.65) for early-term (37 to 38 weeks), compared with full-term (39 to 41 weeks). These risks declined but remained significantly elevated after additional follow-up (pre-term vs. full-term, 10 to 19 years: aHR: 1.86; 95% CI: 1.73 to 1.99; 20 to 29 years: aHR: 1.52; 95% CI: 1.45 to 1.59; 30 to 43 years: aHR: 1.38; 95% CI: 1.32 to 1.45). These findings did not appear attributable to shared genetic or environmental factors within families. Additional pre-term deliveries were associated with further increases in risk. Conclusions: In this large national cohort, pre-term delivery was a strong independent risk factor for IHD. This association waned over time but remained substantially elevated up to 40 years later. Pre-term delivery should be recognized as a risk factor for IHD in women across the life course.
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44.
  •  
45.
  • Crump, Casey, et al. (author)
  • Preterm birth and psychiatric medication prescription in young adulthood: a Swedish national cohort study.
  • 2010
  • In: International Journal of Epidemiology. - : Oxford University Press (OUP). - 1464-3685 .- 0300-5771. ; Jul 1, s. 1522-1530
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Recent studies suggest an increased risk of adverse mental health outcomes among young adults who were born preterm. These studies have been based mainly on hospital data, thus missing large numbers of mental health problems that do not require inpatient treatment. We used national outpatient and inpatient pharmacy data to evaluate whether individuals who were born preterm were more likely to be prescribed psychiatric medications during young adulthood than individuals who were born full term. METHODS: A national cohort of all infants born in Sweden from 1973 through 1979 [N = 635 933, including 28 799 who were born preterm (<37 weeks)] was followed to ages 25.5-34.0 years to determine whether psychotropic medications (antidepressants, antipsychotics, anxiolytics, hypnotics/sedatives and/or psychostimulants) were prescribed in 2005-06. RESULTS: A trend of increasing rate of prescriptions for antipsychotics, antidepressants and hypnotics/sedatives in young adulthood was observed by earlier gestational age at birth. Young adults who were extremely preterm at birth (23-27 weeks) were 3.1 times more likely to be prescribed antipsychotics [95% confidence interval (CI) 1.66-5.93], 1.8 times more likely to be prescribed antidepressants (95% CI 1.26-2.64) and 1.8 times more likely to be prescribed hypnotics/sedatives (95% CI 1.15-2.96) than individuals who were full term at birth, after adjusting for potential confounders. CONCLUSIONS: This national cohort study, using outpatient and inpatient pharmacy data, suggests that preterm birth has important independent effects on mental health that extend at least into young adulthood.
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46.
  • Crump, Casey, et al. (author)
  • Preterm birth and risk of chronic kidney disease from childhood into mid-adulthood : National cohort study
  • 2019
  • In: BMJ (Online). - : BMJ. - 1756-1833 .- 0959-8138. ; 365
  • Journal article (peer-reviewed)abstract
    • Objective To investigate the relation between preterm birth (gestational age <37 weeks) and risk of CKD from childhood into mid-adulthood. Design National cohort study. Setting Sweden. Participants 4 186 615 singleton live births in Sweden during 1973-2014. Exposures Gestational age at birth, identified from nationwide birth records in the Swedish birth registry. Main outcome measures CKD, identified from nationwide inpatient and outpatient diagnoses through 2015 (maximum age 43 years). Cox regression was used to examine gestational age at birth and risk of CKD while adjusting for potential confounders, and co-sibling analyses assessed the influence of unmeasured shared familial (genetic or environmental) factors. Results 4305 (0.1%) participants had a diagnosis of CKD during 87.0 million person years of follow-up. Preterm birth and extremely preterm birth (<28 weeks) were associated with nearly twofold and threefold risks of CKD, respectively, from birth into mid-adulthood (adjusted hazard ratio 1.94, 95%confidence interval 1.74 to 2.16; P<0.001; 3.01, 1.67 to 5.45; P<0.001). An increased risk was observed even among those born at early term (37-38 weeks) (1.30, 1.20 to 1.40; P<0.001). The association between preterm birth and CKD was strongest at ages 0-9 years (5.09, 4.11 to 6.31; P<0.001), then weakened but remained increased at ages 10-19 years (1.97, 1.57 to 2.49; P<0.001) and 20-43 years (1.34, 1.15 to 1.57; P<0.001). These associations affected both males and females and did not seem to be related to shared genetic or environmental factors in families. Conclusions Preterm and early term birth are strong risk factors for the development of CKD from childhood into mid-adulthood. People born prematurely need long term follow-up for monitoring and preventive actions to preserve renal function across the life course.
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47.
  • Crump, Casey, et al. (author)
  • Preterm birth and risk of epilepsy in Swedish adults
  • 2011
  • In: Neurology. - 1526-632X. ; 77:14, s. 1376-1382
  • Journal article (peer-reviewed)abstract
    • Objective: To determine whether preterm birth is associated with epilepsy in a national cohort of adults aged 25-37 years. Methods: We conducted a national cohort study of 630,090 infants born in Sweden from 1973 through 1979, including 27,953 born preterm (< 37 weeks), followed from 2005 to 2009 for 1) hospitalization for epilepsy and 2) outpatient and inpatient prescription of antiepileptic drugs. Epilepsy diagnoses and medication data were obtained from all hospitals and pharmacies throughout Sweden. Results: We found a strong association between preterm birth and epilepsy that increased by earlier gestational age. After adjusting for fetal growth and potential confounders, odds ratios for hospitalization for epilepsy were 4.98 (95% confidence interval [CI] 2.87-8.62) for those born at 23-31 weeks, 1.98 (95% CI 1.26-3.13) for those born at 32-34 weeks, and 1.76 ( 95% CI 1.30-2.38) for those born at 35-36 weeks, relative to those born full-term (37-42 weeks). A similar but slightly weaker trend was observed for the association between preterm birth and antiepileptic drug prescription. These associations persisted after excluding individuals with cerebral palsy, inflammatory diseases of the CNS, cerebrovascular disease, and brain tumors. Conclusions: These findings suggest that preterm birth, including late preterm birth, is strongly associated with epilepsy in Swedish adults aged 25-37 years. This association was independent of fetal growth and was not mediated by cerebral palsy or other comorbidities. Neurology (R) 2011;77:1376-1382
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48.
  • Crump, Casey, et al. (author)
  • PRETERM BIRTH AND RISK OF MEDICALLY TREATED HYPOTHYROIDISM IN YOUNG ADULTHOOD.
  • 2011
  • In: Clinical Endocrinology. - : Wiley. - 1365-2265 .- 0300-0664. ; 75, s. 255-260
  • Journal article (peer-reviewed)abstract
    • Objective: Previous studies suggest that low birth weight is associated with thyroid autoimmunity and hypothyroidism in later life, but the potential effect of preterm birth, independent of fetal growth, is unknown. Our objective was to determine whether preterm birth is independently associated with medically treated hypothyroidism in young adulthood. Design/Participants: National cohort study of 629,806 individuals born in Sweden from 1973 through 1979, including 27,935 born preterm (<37 weeks). Measurements: Thyroid hormone prescription during 2005-2009 (ages 25.5-37.0 years), obtained from all outpatient and inpatient pharmacies throughout Sweden. Results: Preterm birth was associated with increased relative odds of thyroid hormone prescription in young adulthood, after adjusting for fetal growth and other potential confounders. This association appeared stronger among twins than singletons (P=0.04 for the interaction). Twins had increased relative odds across the full range of preterm gestational ages, whereas singletons had increased relative odds only if born very preterm (23-31 weeks). Among twins and singletons, respectively, adjusted odds ratios for individuals born preterm (<37 weeks) were 1.54 (95% CI, 1.11-2.14) and 1.08 (95% CI, 0.98-1.19), and for individuals born very preterm (23-31 weeks) were 2.62 (95% CI, 1.30-5.27) and 1.59 (95% CI, 1.18-2.14), relative to full-term births. Conclusions: This national cohort study suggests that preterm birth is associated with an increased risk of medically treated hypothyroidism in young adulthood. This association was independent of fetal growth and appeared stronger among twins than singletons. Additional studies are needed to confirm these new findings in other populations and to elucidate the mechanisms.
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49.
  • Crump, Casey, et al. (author)
  • Preterm birth and risk of sleep-disordered breathing from childhood into mid-adulthood
  • 2019
  • In: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 48:6, s. 2039-2049
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Preterm birth (gestational age <37 weeks) has previously been associated with cardiometabolic and neuropsychiatric disorders into adulthood, but has seldom been examined in relation to sleep disorders. We conducted the first population-based study of preterm birth in relation to sleep-disordered breathing (SDB) from childhood into mid-adulthood.METHODS: A national cohort study was conducted of all 4 186 615 singleton live births in Sweden during 1973-2014, who were followed for SDB ascertained from nationwide inpatient and outpatient diagnoses through 2015 (maximum age 43 years). Cox regression was used to examine gestational age at birth in relation to SDB while adjusting for other perinatal and maternal factors, and co-sibling analyses assessed for potential confounding by unmeasured shared familial factors.RESULTS: There were 171 100 (4.1%) persons diagnosed with SDB in 86.0 million person-years of follow-up. Preterm birth was associated with increased risk of SDB from childhood into mid-adulthood, relative to full-term birth (39-41 weeks) [adjusted hazard ratio (aHR), ages 0-43 years: 1.43; 95% confidence interval (CI), 1.40, 1.46; P <0.001; ages 30-43 years: 1.40; 95% CI, 1.34, 1.47; P <0.001]. Persons born extremely preterm (<28 weeks) had more than 2-fold risks (aHR, ages 0-43 years: 2.63; 95% CI, 2.41, 2.87; P <0.001; ages 30-43 years: 2.22; 95% CI, 1.64, 3.01; P <0.001). These associations affected both males and females, but accounted for more SDB cases among males (additive interaction, P = 0.003). Co-sibling analyses suggested that these findings were only partly due to shared genetic or environmental factors in families.CONCLUSIONS: Preterm-born children and adults need long-term follow-up for anticipatory screening and potential treatment of SDB.
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50.
  • Crump, Casey, et al. (author)
  • Preterm birth and risk of type 1 and type 2 diabetes : a national cohort study
  • 2020
  • In: Diabetologia. - : Springer Science and Business Media LLC. - 0012-186X .- 1432-0428. ; 63:3, s. 508-518
  • Journal article (peer-reviewed)abstract
    • Aims/hypothesis: Preterm birth (gestational age <37 weeks) has been associated with insulin resistance early in life. However, no large population-based studies have examined risks of type 1 and type 2 diabetes and potential sex-specific differences from childhood into adulthood. Clinicians will increasingly encounter adults who were born prematurely and will need to understand their long-term risks. We hypothesised that preterm birth is associated with increased risks of type 1 and type 2 diabetes into adulthood. Methods: A national cohort study was conducted of all 4,193,069 singletons born in Sweden during 1973–2014, who were followed up for type 1 and type 2 diabetes identified from nationwide diagnoses and pharmacy data to the end of 2015 (maximum age 43 years; median age at the end of follow-up 22.5 years). Cox regression was used to adjust for potential confounders, and co-sibling analyses assessed the influence of shared familial (genetic and/or environmental) factors. Results: In 92.3 million person-years of follow-up, 27,512 (0.7%) and 5525 (0.1%) people were identified with type 1 and type 2 diabetes, respectively. Gestational age at birth was inversely associated with both type 1 and type 2 diabetes risk. Adjusted HRs for type 1 and type 2 diabetes at age <18 years associated with preterm birth were 1.21 (95% CI, 1.14, 1.28) and 1.26 (95% CI, 1.01, 1.58), respectively, and at age 18–43 years were 1.24 (95% CI, 1.13, 1.37) and 1.49 (95% CI, 1.31, 1.68), respectively, compared with full-term birth. The associations between preterm birth and type 2 (but not type 1) diabetes were stronger among females (e.g. at age 18–43 years, females: adjusted HR, 1.75; 95% CI, 1.47, 2.09; males: 1.28; 95% CI, 1.08, 1.53; p < 0.01 for additive and multiplicative interaction). These associations were only partially explained by shared genetic or environmental factors in families. Conclusions/interpretation: In this large national cohort, preterm birth was associated with increased risk of type 1 and type 2 diabetes from childhood into early to mid-adulthood. Preterm-born children and adults may need early preventive evaluation and long-term monitoring for diabetes.
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